Get Clinical Laboratory Improvement Amendments (clia) Application For Certification - Azdhs

This guide provides clear and comprehensive instructions for completing the Clinical Laboratory Improvement Amendments (CLIA) Application For Certification through an online format. By following the steps outlined below, users can ensure that their application is filled out accurately and efficiently, facilitating the certification process for their laboratory.

Follow the steps to complete the CLIA application online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by completing the general information section. Indicate whether you are submitting an initial application, survey, or any changes in certificate type. Provide the facility name, federal tax identification number, email address, telephone number, and physical address of the laboratory.
3. For the type of certificate requested, check the box corresponding to the highest level of testing your laboratory performs, such as a certificate of waiver or accreditation.
4. In the type of laboratory section, select the option that best describes your facility's operation, ensuring to check if it is a shared lab if applicable.
5. Specify the hours of laboratory testing for each day of the week using the HH:MM format or check the box for 24/7 operations.
6. If you are applying for a single-site CLIA certificate to cover multiple testing locations, complete the related section by indicating the applicable regulatory exceptions.
7. In the waived testing section, describe the specific waived tests performed and estimate the total annual test volume.
8. For PPM testing, similarly specify the PPM tests and estimated annual test volume.
9. In the non-waived testing section, detail all non-waived tests performed, including estimated annual test volumes for each specialty.
10. Complete the type of control section by selecting the relevant ownership type of your laboratory.
11. If the laboratory director operates additional laboratories, provide the necessary details in the director affiliation section.
12. Carefully review all provided information for accuracy and completeness. Once verified, save your changes and proceed to download, print, or share your application as needed.

Complete your CLIA application online today to ensure your laboratory's compliance and operation.